Excess/Deficiency and dose changes

Question 1

Estrogen excess

sx and how to adjust CHC and IUD

Answer 1

N, breast tenderness, HA, weight gain/fluid retention - dec estrogen in CHC, consider Progestin only IUD

dysmenorrhea, menorrhagia, uterine fibroid growth - dec estrogen in CHC, consider Progestin only IUD, consider continuous regimen of OC, NSAIDs

Question 2

Estrogen deficiency

sx and how to adjust CHC

Answer 2

vasomotor sx, nervousness, dec libido - inc estrogen content in CHC

early cycle (1-9d), breakthrough bleeding and spotting - inc estrogen content in CHC

amenorrhea - exclude preggo, inc estrogen content in CHC, continue current CHC if pt ok with amenorrhea

Question 3

Progestin excess

sx and change

Answer 3

inc appetite, weight gain, bloating, constipation, acne, oily skin, hirsutism, depression, fatigue, irritability

dec progestin content in CHC or choose a less androgenic CHC

Question 4

Progestin deficiency

sx and change

Answer 4

dysmenorrhea, menorrhagia- inc progestin content in CHC, use continuous OC, Progestin only or IUD, NSAIDs

late cycle (days 10-21) breakthrough bleeding and spotting - inc progestin content in CHC

Question 5

tx for general unscheduled spotting and/or bleeding

Answer 5

NSAIDs 5-7d if on IUD, implant, or injection
can add hormonal tx if implant or injection
if on CHC, hormone free interval for 3-4 consecutive days no more than once per month